Tuberculosis: A rocky road for women’s health

Owen Nyaka, CNS Correspondent, Malawi
“TB needs to be taken seriously as a women’s health issue because it kills more than half a million women a year and makes more than 3 million women sick annually”. This is what Paula I Fujiwara, Scientific Director, and Riitta Dlodlo, Director, Department of Tuberculosis and HIV of the International Union Against Tuberculosis and Lung Disease (The Union), say in commemorating World TB Day 2015.
In 2013 alone; an estimated 37% (3.3 million) of the total 9.0 million new incident cases of TB were in women and 510, 000 TB deaths among women The African and South-East Asia regions account 69% of the cases among women.

The plight of women and girls affected by TB continues unabated, especially in low and middle income countries. Stories of women with TB make media headlines very rarely, if at all. For instance early this year in January, 40 years old Kausalya Deshmukh of Mumbai, India, jumped to her death. According to news reports, she had been receiving ineffective treatment for multidrug-resistant TB (MDR-TB) for two years. She was depressed, and the adverse effects of the medicines had left her permanently deaf. In 2011, the then 14 years old Zehra Begum set herself on fire in her home in Hyderabad, India and died in the hospital. She resorted to such drastic measure to end her struggle of fighting MDR-TB for over one year with no visible results.

Stigma
The stories above reveal the tragic results of the stigmatization of TB, amongst women. But this is not the situation just in India. Gender inequality around the world makes women more vulnerable, particularly to stigma associated with TB, even as the disease is the third leading cause of death in women worldwide.

TB-related suicides have been driven by the depression and feelings of stigma and dejection that come with having MDR-TB. TB is often seen as a ‘man’s disease’ and women sometimes fear the social consequences of a TB diagnosis just as much if not more than the health implications.

TB poses a variety of deep threats to women’s lives medically, economically, and socially. In some countries where TB is common, traditional gender dynamics prevent women from going to the clinic on their own to seek treatment and care, leaving the disease to advance into critical stages.

Social and cultural norms
Various social and cultural factors can lead to increased vulnerability. For example, a study in Pakistan reported that many women either felt uncomfortable or misunderstood how to produce the mucus sample needed for a TB diagnosis. Additionally, women in developing countries tend to cook with biomass fuels that have been shown to negatively impact lung health and increase risk of TB.

Women diagnosed with TB face risks of ostracism from their families and communities, divorce from their spouses, or being deemed ‘unmarriageable’. They also face the risk of losing their jobs should their status be disclosed. Fear of such consequences can prevent women from getting screened or seeking treatment.

“We call for a permanent end to the stigma and abuse that women with TB routinely endure on top of the pain and suffering they experience from the disease itself. We call for access to quality TB treatment for all women. We must all recognize TB as an important women’s health issue that demands urgent attention and work together for its elimination,” said a statement by International Union Against Tuberculosis and Lung Disease ahead of International Women’s Day.

TB in women
TB progresses more quickly in women of reproductive age than in men of the same age group. Women are more likely to die from TB than men of the same age and condition. Women with TB are twice as likely to give birth to a premature or low-birth-weight baby and four times more likely to die in childbirth. Mother to child transmission of TB is estimated to be 15% within three weeks of birth.

“We need to reduce stigma by educating people about what TB really is. Anyone can get TB, rich or poor, man or woman. People with TB, including women with TB, deserve compassion and the best medical care available. At the same time we are educating people, we can be stigmatizing those who stigmatize. We need to make it socially unacceptable to stigmatize people who are sick with TB or with any other disease,” said Paula Fujiwara to CNS.